The News Line: FeatureFriday, 13 January 2006FAR REACHING CHANGES TO BE IMPOSED ON THE NHSTHE Blair government is trying to impose ‘far-reaching changes’ to the NHS – without any real consultation with the public.

That is the finding of the House of Commons Health Committee, in its report on planned changes to Primary Care Trusts (PCTs).

The changes will mean the transfer of services and staff to the private sector, in the teeth of massive opposition from the public and within the NHS itself.

The MPs say the aim of the changes, just three years after the last ‘root and branch reforms’ is to achieve spending cuts.

But the changes will mean more taxpayers’ money will end up in the coffers of health privateers.
The PCTs are ‘currently responsible for spending 80 per cent of the NHS’s £76 billion budget’.

Summarising the conclusions of their report, the MPs say: ‘(10) Despite the government’s repeated reassurance that this is not a “top down” process, with change being imposed on local NHS organisations from central government, the evidence we have received from those working in the NHS at a local level suggests that it is exactly that.

‘This is because, in their view, the most significant driver of these reforms is finance and so solutions that would best meet local needs are being overruled because they do not yield enough cost savings.’

The MPs note that the PCTs were only established three years ago ‘at considerable cost to the taxpayer’.

Imposing further change when NHS organisations are already under enormous pressure. . . ‘is ill-judged in the extreme’.

The MPs add: ‘(16) There are also well-founded concerns that patient care will suffer as a direct result . . . our evidence suggests that the destabilising effects are already being felt across the NHS’.

Clinical staff are moving from community hospitals to the ‘acute sector’ because of the uncertainty over their future.

The MPs state: ‘(2) We are appalled at the continuing lack of clarity about whether or not PCTs will eventually divest themselves of their provider functions.

‘This announcement was first made at the end of July, together with a firm timetable for its implementation, which was withdrawn in October.’

Senior NHS managers who gave evidence to the MPs’ committee were themselves ‘genuinely bewildered’ about the government’s plans.

‘As far as we can see,’ the MPs’ report says, ‘the overall direction of travel in fact remains unchanged, and PCTs will ultimately divest themselves of provider services.

‘We urge the Government to either confirm or deny this immediately. (Paragraph 46)’

If the Primary Care Trusts no longer act as providers of health care, then they will in future be merely ‘commissioners’, who pay others to provide services.

Like local councils who pay contractors to carry out repairs, they will ‘commission’ health care from private companies.

PCTs Boards will also be privatised, so that privateers will be purchasing health care for NHS patients from private companies.

The NHS will become an NHS in name only.

The MPs’ report deals with the privatisation to come when it discusses the ‘transfer’ of primary care staff to private companies.

The report says: ‘(3) We are deeply concerned that neither Lord Warner nor John Bacon were able to give us a confident assurance that NHS staff potentially affected by these changes would be able to retain their NHS pensions.

‘The Government must provide clear information as to whether existing NHS staff who are transferred to other providers, particularly in the private sector, as a result of these changes will be able to retain their NHS pensions. (Paragraph 47)’

The MPs’ report suggests the government’s ‘consultation’ on these changes so far has been a sham.

‘(4) Perhaps most concerning of all is that these announcements about the future of PCT provided community services, anticipate the outcome of the Government’s flagship consultation Your Health, Your Care, Your Say, which is supposed to shape the Government’s forthcoming White Paper on out-of-hospital care.

‘For a Government to announce its intended direction of travel a full five months before its consultation on this subject comes to an end makes a mockery of the consultative process. . .

‘(6) The insecurity and distraction that has been caused within NHS community health services demonstrates how damaging the repercussions of ill-thought through policy announcements can be.’

While the government’s stated aim is to ‘design a more patient-led NHS’, evidence from both NHS bodies and ‘Patient and Public Involvement Forums’ confirmed that patients and the public had ‘not been adequately consulted’.

‘We find this unacceptable,’ the MPs said.

They added: ‘(8) Even NHS officials who otherwise supported the proposals to merge PCTs have described the initial consultation process as “flawed”.

‘In some cases, organisations were given less than a month, during the summer holidays when many key figures were absent, to put together proposals for far-reaching changes to local services.

‘The timing also meant that many local MPs and councillors were unable to contribute to the process.’

Another ‘very serious concern’ of the MPs is that ‘(11) . . . SHAs (Strategic Health Authorities) are having to design new organisations without a clear understanding of what their ultimate function will be.

‘This could lead to the formation of organisations which are not fit for purpose’.

‘(19) Equally, it seems illogical that, at precisely the time the Government has committed to improving NHS commissioning, it is currently planning to spend £250 million less per year on this crucial function. . .’
There are currently 302 Primary Care Trusts in England.

Each has a panel of Non-Executive Directors; a Patient and Public Involvement Forum; and a Professional Executive Committee of local doctors.

The PCTs were established ‘to ensure that decisions about the NHS were made locally’, say the MPs.

‘(20) By reverting back to the more remote structures that were abolished only three years ago, this localism will be lost.’

So-called Practice Based Commissioning by GPs ‘underpins the Government’s proposals’, said the MPs.

However, GPs who gave evidence to the Health Committee described a ‘woeful lack of information’ about the scheme.

The MPs said there is a ‘(24) very real possibility of Practice Based Commissioning introducing perverse incentives that could threaten patient choice and access to health care.’

This is ‘worrying’, say the MPs, given that the government hopes Practice Based Commissioning ‘will be universally implemented within a year’.

The MPs also found that PCTs are collaborating with one another and, as a result, ‘bringing about improvements without the need for large-scale reorganisation.’

The MPs state that: ‘(32) Whether or not PCTs should divest themselves of their provider services is a huge question which is outside the scope of this short inquiry.’

However, those who gave evidence to them ‘raised many important concerns about the divestment of PCT provider services, most notably that it would lead to fragmentation of services. . .’

Finally, the MPs’ committee says: ‘(33) We were extremely concerned at evidence we received about proposals to tender out the commissioning function in Oxfordshire before the new PCT Board has even been appointed.’

This ‘outsourcing’ (privatisation) represents ‘a significant departure from current policy’.

It has ‘the potential’, the MPs say, of preventing the public from having a ‘transparent’ view of where NHS funds are going.

‘Further consultation and discussion is absolutely crucial before the Government allows any PCT to proceed down this route. (Paragraph 187)’

The report by the Health Committee of MPs clearly reveals that the government’s drive is to privatise the NHS at every level.